Effect of antithrombic therapy on bleeding complications in patients receiving emergency cholecystectomy for acute cholecystitis

Abstract

Background The risk of developing hemorrhagic complications during or after emergency cholecystectomy in patients with antithrombic therapy (ATT) remains uncertain. In this study, we evaluate outcomes in patients with ATT undergoing emergency cholecystectomy and assess the relevance between ATT and perioperative complications including bleeding complications. Methods We retrospectively evaluated 296 patients who were diagnosed as acute cholecystitis and underwent emergency cholecystectomy between 2005 and 2017. One hundred and thirty‐three of them (45%) were on ATT. The primary outcome measures were intraoperative blood loss over 500 ml and postoperative complications including bleeding complications. This study was approved by our institutional review board (#13072904). Results There were 23 patients (8%) who experienced intraoperative blood loss over 500 ml and nine postoperative bleeding complications (3%). Multivariable analyses showed that male sex (P = 0.027), Performance Status 2–4 (P = 0.031) and grade II or III acute cholecystitis (P = 0.033) were independent risk factors for intraoperative bleeding over 500 ml, whereas not single antiplatelet therapy (APT) use but multiple APT (P = 0.034) and anticoagulation therapy (ACT) (P = 0.032) were independently associated with postoperative bleeding complications. Additionally, laparoscopic surgery, but not ATT, was a significant prognostic factor for severe postoperative complications. Conclusions Single APT was not remained as an independently associated factor of intraoperative excessive bleeding or severe postoperative complications including bleeding complications. However, patients treated with multiple APT or ACT still represent a challenging group and must be carefully managed to avoid postoperative bleeding complications.

Effect of Perioperative Antiplatelet Management on Thromboembolic Complications after Liver Resection

“…Regarding the bleeding risks, the safety of preoperative single APT continuation during various types of surgery has been reported [4][5][6][7][8][9][10] . Although some studies including POISE-2 study have reported a slight increase in bleeding risks after non-cardiac surgery in patients with APT continuation [4,5] , most studies have shown that preoperative APT continuation is not associated with significant bleeding complications [6][7][8][9] .…”

Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review

“…Research article collection and screening were conducted from January 2019 to February 2019. A total of 8 studies on surgical cholecystectomy (mainly LC), [11][12][13][14][15][16][17][18] 3 studies on PTGBD, [19][20][21] and 1 study on EGBD 5 in patients receiving ATT were selected for data extraction and satisfied our inclusion criteria. As only 1 study on EGBD in patients receiving ATT was retrieved through the search method mentioned above, articles were additionally searched using the keywords "ETGBD" and "EUS-GBD".…”

“…In the 12 studies that evaluated surgery and gallbladder drainage, patients receiving ATT, including aspirin and/or thienopyridine, were the focus of 3 studies. 12,14,15 Only 1 study evaluated patients receiving anticoagulant therapy with heparin bridging, 11 1 study evaluated patients receiving anticoagulant therapy and/or with coagulopathy, 19 and the other studies 5,13,[16][17][18]20,21 evaluated patients receiving antiplatelet agents and/or anticoagulants during surgery (LC or OC) or internal drainage (PTGBD or EGBD) without discontinuation of ATT (Table 1).…”

“…13,16 On the other hand, 2 studies on cholecystectomy in patients receiving antiplatelet agents and/or anticoagulants reported that anemia was more frequently observed in patients who underwent emergency LC with continuation of ATT, 17 and that treatment with multiple antiplatelet therapies and anticoagulation therapies was an independent predictor for postoperative bleeding complications. 18 Moreover, in a study on LC, it was proven that patients receiving heparin bridging therapy had a significantly higher rate of surgical blood loss than those without anticoagulants. 11 Overall, bleeding complications occurred in 6.5% (23/354) of patients with ATT and in 1.2% (26/2,224) of patients without ATT (p<0.001).…”

“…[11][12][13][14][15][16][17][18] Several studies reported that LC in patients receiving ATT might not increase bleeding-related events. [12][13][14][15][16][17] On the contrary, other studies reported that emergency LC has a significant risk of bleeding complications in patients receiving mono-or multiple ATT, 17,18 and in those receiving heparin bridging therapy. 11 In our review, 6.5% of the patients receiving ATT who underwent LC (OC in part) experienced bleeding complications, and the rate was significantly higher than that in patients without ATT.…”